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Elizabeta Evtimovska, DDS, MS, is a maxillofacial prosthodontist at Penn Medicine. In this article, she discusses chemotherapy and radiation therapy for head and neck cancer, their complications, and how patients can prevent long-term side effects of head and neck cancer treatment.

Chemotherapy and radiation therapy for head and neck cancer can cause a range of short and long-term oral complications.

The acute complications such as mucositis (sores) and infections, as well as others are managed by the oncology team during the treatment. Some of the long-term complication, such as xerostomia (dry mouth) and osteoradionecrosis (ORN), is a serious complication of radiation therapy for head and neck cancer that occurs in a small percentage of patients as result of head and neck radiation treatment.

Osteoradionecrosis is bone that has died. Because radiation works to destroy cancerous cells through the deprivation of oxygen and vital nutrients, it inevitably destroys normal cells as well, damaging small arteries and reducing circulation to the area of the mandible (jaw bone).

As there is no treatment for ORN, the focus is on prevention. This means, avoiding extractions of teeth from the radiated parts of the jaws and making sure that dentures fit properly and don’t cause any sores. It most often occurs in the setting of tooth extraction from the radiated parts of the jaws, but can also occur spontaneously. In both cases, there is exposed bone in the mouth which can be asymptomatic or it can be further complicated by infections, pain, and/or malodor.

Preparing for Chemotherapy and Radiation Therapy for Head and Neck Cancer

Patients who are planning to undergo chemotherapy or radiation therapy for head and neck cancer should be evaluated by a dentist prior to the start of treatment.

During this appointment, the patient’s oral condition is evaluated and it is determined if any teeth need to be extracted prior to the start of radiation therapy. This visit is also a perfect time to go over good oral health care.

In our practice, I advise patients to do the following during and after radiation:

• Maintain excellent oral hygiene by flossing and brushing every morning and evening and after every meal. If dry mouth develops, it is especially crucial to brush teeth after every meal and only drink water between meals, as opposed to sugary drinks or snacks.
• Use fluoride to prevent caries (when xerostomia, dry mouth, is present, the patient has increased risk of caries). Fluoride is especially important to prevent extracting teeth from the radiated parts of the jaws and therefore prevent osteoradionecrosis.
• Visit a local dentist regularly for regularly scheduled maintenance visits (cleanings), as well as any other routine dental treatment.

The severity of oral complications from chemoradiation differs depending on the diagnosis, the type of treatment administered, the amount and location of the delivered radiation, etc. Therefore, it is best to consult with a dentist prior to and after radiation in terms of the above discussed needs and recommended treatment.

Learn about managing cancer treatment side effects.

Learn about the Abramson Cancer Center Center’s Center for Head and Neck Cancer.